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PubMed1996

Perception, reality, and the political context of conflict of interest in university-industry relationships.

The crucial issues in a policy debate are often matters of perception and interpretation rather than fact, and the values and norms that influence perceptions are central to an understanding of conflict in the policy arena. For example, science's norms of objectivity and disinterestedness are being modified today to accommodate closer academic-industry ties. The author traces in detail how these ties and the accompanying public distrust have developed, beginning with the post-World-War-II increase in public support for basic research and continuing with subsequent pieces of legislation that lowered the barriers between academic and industrial research in order to reap economic benefits. He then analyzes the impact of financial incentives in university-industry relationships on science and on public perceptions of science, and the price both science and the public would pay if the public loses trust in science and refuses to support it. He also reviews the history of the ill-fated National Institutes of Health guidelines for university-industry collaborations proposed in 1979 and the subsequent history of the policy on this topic recently adopted by the Public Health Service. He maintains that the PHS policy poses both a risk (the temptation to enforce the policy loosely) and an opportunity (for research institutions to grasp the initiative and develop meaningful conflict-of-interest guidelines of their own). But the policy falls short of responding to the much broader range of concerns associated with university-industry research collaboration, for example, the possible effects of such collaboration on the traditional openness and sharing among scientists. The available data on these effects are mixed. He concludes by maintaining that scientists and their industry partners should address the issues surrounding their collaboration now rather than waiting for negative events to trigger public arousal and force a mutually unsatisfying political solution. This article is one of three in this issue of Academic Medicine that deal with issues of conflict of interest in university-industry research relationships. These articles are discussed in an overview that precedes them.

Biomedical Research↗

PubMed1992

Influence of political power, medical provincialism, and economic incentives on the rationing of surgical intensive care unit beds.

OBJECTIVE: To determine factors influencing rationing decisions in a surgical ICU during a temporary nursing shortage when two to six of the unit's 16 beds were closed. DESIGN: Blinded, concurrent data collection, retrospective chart review. SETTING: Surgical ICU. PATIENTS: All patients (n = 308) for whom a surgical ICU bed was requested were studied during a 3-month period. MEASUREMENTS AND MAIN RESULTS: Admitting patterns did not change and no attempts were made to limit admissions to more severely ill patients during times of the greatest shortage of surgical ICU beds. Contrary to findings in previous reports, the severity of illness of patients admitted to the surgical ICU decreased as bed availability and bed census decreased. Bed allocation across surgical services was influenced by factors other than medical suitability. Of major users, cardiothoracic surgery experienced the highest percentage (59%) of all patient admissions and lowest percentage (1.6%) of all denied admissions. General surgery experienced the lowest percentage (15%) of all admissions and highest percentage (10.4%) of all denied admissions, although these patients had the highest average Acute Physiology and Chronic Health Evaluation (APACHE II) scores for all patients admitted (17.7) and for patients denied admission (15.8). CONCLUSIONS: Surgical attending physicians rarely used other open inhouse ICU beds when surgical ICU beds were unavailable. Political power, medical provincialism, and income maximization overrode medical suitability in the provision of critical care services.

Adult↗

PubMedDate not supplied

The political and policy implications of a rating system of community capacity to improve population health.

This article discusses the political and policy implications of a potential rating system of community capacity for health improvement. Evidence suggests that such a rating system will have little effect in the current health care environment unless it is directly related to the health care dollar. Community change agents and stakeholders, including the growing population of older adults, will perceive a rating system to have value only if the defined purpose meets their interests and needs, and if the rating system results prove useful for decisions that affect the bottom line in working on issues like health improvement and capacity.

Community Health Services↗

PubMed1992

Executive leadership, community action, and the habits of health care politics.

Health care executives must lead the way to the comeback of "voluntarism" in their field. This will require having four key political habits: (1) acting out of a sense of civic responsibility, (2) avoiding the dangers of faction and "magic bullets", (3) building alliances by a process of conferring with other relevant leaders and groups, and (4) participating in community activism, i.e., acting on, not reacting to, local problems and pressures.

Community Participation↗

PubMedDate not supplied

The policy and political context of defending Medicaid.

Medicaid is often accused of devouring state budgets. In reality, it is a sharp decline in revenue that has precipitated the current state fiscal crisis, not the growth of health care spending. Nonetheless, in a climate of scarce resources, proponents of maintaining health coverage for low-income people through the Medicaid program face a complex challenge that requires them to think simultaneously about policy and building a political constituency for health care for the poor. At the same time, they must challenge the conventional wisdom that argues against raising taxes in times of economic weakness.

Adult↗

PubMedDate not supplied

Planning a large ambulatory care center at an academic medical center: economic, political, and cultural issues.

The Massachusetts General Hospital developed a series of space and utilization guidelines that assisted in the planning of a 450,000-ft ambulatory care facility. The guidelines attempted to balance and preserve the critical elements of the hospital's culture while, at the same time, create a highly efficient ambulatory care building. This article discusses the economic, political, and cultural implications of implementing specific project principles and guidelines known as the "9 Commandments."

Academic Medical Centers↗

PubMedDate not supplied

Community health centers' impact on the political and economic environment: the Massachusetts example.

Since their inception in 1965, community health centers have thrived against tough odds, including patchwork funding, an unpredictable public policy environment, and a volatile healthcare marketplace. Much of this long-term success has been attributed to the centers' ability to affect their economic and political environment. Massachusetts provides an excellent example of this outward orientation. It was here that the centers first took hold, grew rapidly as a result of grassroots activity, and came together as a group for advocacy and mutual assistance. This article examines the Massachusetts experience in light of the health centers' ability to survive and grow.

Community Health Centers↗

PubMed1976

Token economies in institutional settings. Historical, political, deprivation, ethical, and generalization issues.

The use of the token economy in institutional settings is examined in light of historical, political, deprivation, ethical, and generalization issues. The major points may be summarized as follows. a) The token economy may be viewed as a palliative measure to prevent the incredibly regressive effects of institutionalization. b) To achieve control in token programs in many "total institutions," an artificial state of deprivation must be achieved. c) Generalization of behaviors into the natural environment following the patient's stay in a token economy program should not be taken for granted. d) What the patient learns in a token economic system may not be what the token economy's program director probably intends.

Behavior Therapy↗

PubMed2000

Anger in former East German political prisoners: relationship to posttraumatic stress reactions and social support.

Anger is a salient symptom of traumatized victims and a major sign for posttraumatic stress disorder (PTSD). However, the causes for the increased level of anger remain almost unknown. The present study investigates the interrelationship of anger, posttraumatic stress reactions, and social support in a group of former East German political prisoners (N = 91). Assessments included the German version of the Anxiety Disorders Schedule (DIPS) as well as measures of anger (STAXI), posttraumatic stress reactions (IES-R), and social support (SSQ). As expected, participants reported a high level of anger. Most measures of anger, posttraumatic stress reactions, and social support were significantly correlated. Within structural equation modeling, trait-anger was shown to be directly activated by the experience of chronic posttraumatic intrusions. Social support appeared to lessen the level of anger. The results confirm findings from studies on other traumatic events and provide additional information on the relationship between posttraumatic anger and social support. The findings indicate that treatments for PTSD might be effectively supplemented by addressing anger and social support.

Analysis of Variance↗

PubMed1988

Community planning for medical support of a national political convention.

A large political gathering such as the 1984 Republican National Convention provided the ingredients necessary to challenge a community's medical system. A committee consisting of representatives from the city, the county hospital district, the Dallas County Medical Society, and the American Red Cross coordinated their efforts toward developing a comprehensive plan to provide medical support for all aspects of the convention. Provisions to deal with the following potential problems included: 1) the extreme heat; 2) security; 3) massive crowds on the convention floor; 4) the area in which the demonstrators were staying as well as the area in which the demonstrations were to occur; 5) special requirements for visiting dignitaries; and 6) terrorism. Eighty patients were seen in the protest area. Thirty-nine patients were treated by the Red Cross, and 518 patients were seen in the convention center. Ten patients required transportation to the hospital. Organization, coordination, and cooperation of all personnel and appropriate agencies helped ensure a smooth operation.

Community Health Services↗

PubMedDate not supplied

Addressing social, political, and health issues. The student congress strategy.

The authors describe a classroom instructional strategy used to resolve current social, political, and health issues. The strategy includes participation in group work and database searching in the preparation of proposed resolutions. The class serves as a Student Congress, voting for or against the resolutions presented. This instructional model could be used in any university classroom if the goal is to enhance critical-thinking skills and to heighten a sense of social and personal responsibility.

Education, Nursing, Baccalaureate↗

PubMed1989

Political theory and individualistic health promotion.

The grounding of the individualistic self-care-behavior approach to health promotion in classical liberal political theory is made explicit by uncovering the correspondence between the assumptions of the two. Questions are raised about whether the problems attributed to liberal theory are reflected in the results obtained with individualistic health promotion. It is suggested that for nurses to engage in socially responsible health promotion, they may need to reconceptualize health promotion using a feminist perspective.

Health Promotion↗

PubMed2000

Nursing's gender politics: reformulating the footnotes.

Nursing's survival in the new millennium necessitates the application of a fresh lens to the manner in which nurses participate in and perpetuate the insidious nature of their oppression. This article critically explores the language and activities that annotate nursing's gender politics to expose how language and power intersect, facilitating the development of a language of social change. Self-deception is found to be a central organizing concept of professional and service delivery organizations that perpetuates professional mediocrity, limits freedom of thought and action, and preserves the borderline status of nurses. Dialogue inclusive of the internal and external systems operating to oppress nurses is suggested to transform nurses as collective social agents and reframe their sociopolitical reality.

Attitude of Health Personnel↗

PubMedDate not supplied

The politics of suffering: implications for nursing science.

Drawing on newly emergent conceptualizations of suffering in the social sciences that emphasize political dimensions, this article uses a critical-feminist, self-reflective approach to propose a reconceptualization of suffering for nursing science. Discourse analysis of local narratives and metanarratives is undertaken as a basis for proposing alternative methods, including a critical humanities approach, for nurse scholars to use in creating a transformed, politicized epistemology of suffering.

Asian↗

PubMed2006

Attempt to eliminate health inequalities in Poland arising at the time of political and economic transformation: Polish 400 Cities Project.

AIM: Epidemiological data show that citizens of small towns and villages have presented worse trends in cardiovascular mortality during the political, social and economic transformation in Poland during past 15 years than citizens of large towns. To try to eliminate these inequalities the Polish 400 Cities Project (P400CP), a large educational and interventional project, was prepared. The project consists of two arms: medical and social interventions. MATERIAL AND METHODS: The main aim of the medical screening intervention in P400CP is to increase detection and control of cardiovascular risk factors in inhabitants of 418 small cities (<8000 inhabitants) and surrounding villages, particularly in men and people of lower education. In 2003 and 2004 the P400CP covered 123 cities. All together, 36 696 subjects aged between 18 and 98 years were examined. In all participants, blood pressure (BP), anthropometric measurements, laboratory tests and questionnaire interviews were performed. The social arm of P400CP is one of multi-level educational intervention. Modern techniques of social psychology and marketing were involved to increase participation in interventions. RESULTS: Only 12.5% of all subjects had normal BP, cholesterol (<190 mg/dl) and glucose (<100 mg/dl in whole capillary blood) levels. During the first screening visit 65.5% of all examined subjects had BP>/=140 mmHg or >/=90 mmHg. The fasting glucose level was increased in 19% of women and 26% of men. Almost two-third of all subjects had a total cholesterol level above the norm. CONCLUSIONS: The prevalence of cardiovascular risk factors in participants of the screening programme P400CP in small towns in Poland was very high. High prevalence and low control of risk factors in participants of the P400CP confirm the decision to target this programme at citizens of small towns and villages.

Adolescent↗

PubMed2006

Political life and half-life: the future formulation of nuclear waste public policy in the United States.

The United States continues to need forward-thinking and revised public policy to assure safe nuclear waste disposal. Both the high- and low-level disposal plans enacted by Congress in the 1980's have been frustrated by practical and political interventions. In the interim, ad hoc solutions and temporary fixes have emerged as de facto policy. Future statutory, regulatory, and administrative guidance will likely be less bold, more narrowly focused, and adopted at lower levels of government, more informally, in contrast to the top-down, statutory policies of the 1980's.

Decision Making↗

PubMed1989

Political power for neuroscience nurses.

This article reviews the legislative process at the national level and gives individual and group strategies neuroscience nurses can utilize to influence legislators and become involved in the political arena. In addition, selected current health care legislative issues are presented along with AANN's categories for prioritizing legislative action.

Communication↗

PubMed2002

Donors to charity gain in both indirect reciprocity and political reputation.

Darwinian evolution can explain human cooperative behaviour among non-kin by either direct or indirect reciprocity. In the latter case one does not expect a return for an altruistic act from the recipient as with direct reciprocity, but from another member of the social group. However, the widespread human behaviour of donating to poor people outside the social group, for example, to charity organizations, that are unlikely to reciprocate indirectly and thus are equivalent to defectors in the game is still an evolutionary puzzle. Here we show experimentally that donations made in public to a well-known relief organization resulted both in increased income (that the donors received from the members of their group) and in enhanced political reputation (they were elected to represent the interests of their group). Donations may thus function as an honest signal for one's social reliability.

Cooperative Behavior↗